Spatial-temporal patterns and typology of attacks against healthcare in the Occupied Palestinian Territory.

Abstract

Background: Healthcare infrastructure, personnel and persons seeking healthcare are protected under international humanitarian law. However, attacks on healthcare are increasingly a part of modern armed conflicts, including in the Occupied Palestinian Territory (oPt).

Aim: To quantify and characterize reported attacks on healthcare in the West Bank and Gaza and correlate reported attacks involving explosives with publicly available data.

Methods: This retrospective study analysed publicly available and geolocated health facility and weapons data from 7 October 2023 to 30 June 2024. Reports of attacks on healthcare were categorized by location, outcome and typology. Z-test and Chi-square analyses were conducted to compare attack types between Gaza and the West Bank using R software, and geospatial analyses were conducted using ArcGIS Pro software.

Results: A total of 1280 attacks on healthcare were reported in the oPt during the study period, of which 1052 were included in the analysis. Most of the attacks occurred in Gaza (78.3%), followed by the West Bank (21.7%). The typology of these attacks varied. There was a significant difference between the types of attacks in Gaza and West Bank (P < 0.05), but no significant association between type of weapon used and type of attack in Gaza (|R| < 2). The hotspots of attacks in Gaza were around al-Shifa, Nasser and al-Awda hospitals.

Conclusion: There was a high burden of attacks on healthcare in the oPt during the study period. The differences in types of attacks between Gaza and the West Bank highlight the need for context-specific interventions in the two territories. There is an urgent need for actions to end the use of 2000-lb MK-84 bombs in densely populated areas and near health facilities, in addition to calls for adherence to the international humanitarian law during armed conflicts.